Provider Demographics
NPI:1780172155
Name:KERRIE SMEDLEY, PHD
Entity type:Organization
Organization Name:KERRIE SMEDLEY, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SMEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:717-679-0544
Mailing Address - Street 1:44 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-1411
Mailing Address - Country:US
Mailing Address - Phone:717-966-1388
Mailing Address - Fax:
Practice Address - Street 1:44 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-1411
Practice Address - Country:US
Practice Address - Phone:717-679-0544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017435103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1346476090OtherINDIVIDUAL NPI
PS017435OtherPA LICENSE